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Sleep problems during pregnancy affect glucose, may increase risk of childhood obesity

Sleep apnea

A study conducted by Sarah Farabi, PhD, RN, while she was a post-doctoral fellow working with Teri Hernandez, PhD, at the University of Colorado College of Nursing and School of Medicine in 2018 found that mild sleep apnea changed sugar levels during pregnancy and was connected to infant growth patterns related to increased risk of obesity.

Published in the Journal of Clinical Endocrinology and Metabolism, the study included 18 women who did not have gestational diabetes and a body mass index of 30-40 kg/m2 during their third trimester – making them at higher risk for sleep apnea. Twelve of the 18 participants were diagnosed with sleep apnea. “They were very surprised by the diagnosis. Often unrecognized, obstructive sleep apnea worsens over the course of a pregnancy and is associated with poorer perinatal outcomes like gestational diabetes and bigger babies,” said Farabi.

Sarah Farabi, PhD, RN, former postdoctoral fellow at the University of Colorado College of Nursing
Sarah Farabi, PhD, RN, a former post-doctoral fellow at the University of Colorado College of Nursing

According to Farabi, “In this study, the more severe the mother’s sleep apnea, the more likely she was to have higher blood sugar throughout the day and night. The data indicate that improving sleep habits, as well as screening for and potentially treating sleep apnea may help improve maternal infant outcomes in this high-risk population.” Unlike other studies, the sleep patterns and glucose were directly measured using personal monitoring devices instead of relying on self-report, making the data much stronger in the story they tell.

“We showed that mild undiagnosed sleep apnea is related to higher glucose patterns during pregnancy, even in women who do not have gestational diabetes. By addressing sleep apnea with overweight women during pregnancy, we might be able to improve mother’s sugar levels and insulin resistance, as well as the potential for fetal overgrowth and childhood obesity,” said Farabi. The combination of improved sleep and nutrition patterns may improve maternal and fetal outcomes.

Study participants were monitored at home with a WatchPAT wrist device and finger probe for three consecutive nights. The WatchPAT detects oxygen saturation levels and external movement. During the three days, they also had their diet provided by the Colorado Clinical and Translational Science Bionutrition Core, and wore a monitor that measured glucose every 5 minutes. Two weeks after delivery, a non-invasive test called a PEAPOD measured the baby’s body composition via air displacement.

Currently, Farabi is an assistant professor at Goldfarb School of Nursing.

Guest Contributor: Dana Brandorff, College of Nursing

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Infants born to obese mothers risk developing liver disease, obesity

Infant gut microbes altered by their mother’s obesity can cause inflammation and other major changes within the baby, increasing the risk of obesity and non-alcoholic fatty liver disease later in life, according to researchers at the University of Colorado Anschutz Medical Campus.

The study was published in the journal Nature Communications.

“Alteration of the gut microbiome early in life may precede development of obesity instead of being caused by established obesity,” said the study’s lead author Taylor Soderborg, an MD/PhD candidate in the Integrative Physiology Program at the University of Colorado School of Medicine. “This is the first study to show a causative role of these microbes in priming development of obesity.”

Childhood obesity is a world-wide epidemic with recent predictions saying that 57 percent of today’s children will be obese by age 35. That parallels the rate of maternal obesity which is nearly 40 percent. Obesity increases the risk of non-alcoholic fatty liver disease (NAFLD) which impacts at least 30 percent of obese children. NAFLD can lead to liver failure, requiring a transplant.

Taylor Soderborg
Taylor Soderborg, an M.D./PhD candidate in the Integrative Physiology Program at the University of Colorado School of Medicine.

In this study, researchers looked at two-week old infants born to normal weight mothers and obese mothers.  They took stool samples from infants from both groups and colonized them inside germ-free mice.

They discovered that the gut microbes from babies born to obese mothers caused metabolic and inflammatory changes to the liver and bone marrow cells of the mice. Then, when fed a Western-style high fat diet, these mice were predisposed to more rapid weight gain and development of fattier livers.

“This is the first experimental evidence in support of the hypothesis that changes in the gut microbiome in infants born to obese mothers directly initiate these disease pathways,” Soderborg said.

For the study’s senior author, Jed Friedman, PhD, MS, professor of pediatrics and neonatology at the CU School of Medicine, the findings offer potential hope for understanding how early microbes might go awry in children born to obese mothers.

“About 35 percent of these kids have NAFLD and there is no known therapy for it,” he said. “But if we can alter the microbiome we can change the course of NAFLD.”

Friedman said the study shows that the microbiome can cause the disease rather than simply be associated with it. Newborns of obese mothers, he said, could be screened for potential changes in their gut that put them at risk for NAFLD.

Jed Friedman
Jed Friedman, PhD, MS, professor of pediatrics and neonatology at the CU School of Medicine

“If we could modify the first two weeks of the infant microbiome, we could reduce the risk of this disease,” said Friedman.

That could be done through giving the infant probiotics or other supplements.

Soderborg said future studies on pre and probiotics are needed to better understand how they could help modify the risk of childhood obesity and the risk of liver disease in infants born to obese mothers.

The study co-authors include Sarah E. Clark; Christopher E. Mulligan; Rachel C. Janssen; Lyndsey Babcock; Diana Ir; Dominick J. Lemas; Linda K. Johnson; Tiffany Weir; Laurel L. Lenz; Daniel N. Frank; Teri L. Hernandez; Kristine A. Kuhn; Angelo D’Alessandro; Linda A. Barbour; Karim C. El Kasmi.

 

 

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Liver clinic targets silent epidemic with team approach

After watching the cafeteria lady’s husband die under his team’s care, Thomas Jensen, MD, began focusing on preventing the scenario from happening again. The patient, who had been unknowingly suffering from liver disease, had lost all function of the organ, leaving Jensen and his colleagues nearly helpless.

Wieland and Jensen
Amanda Wieland, MD, and Thomas Jensen, MD, flank a FibroScan® machine, which they often use to quickly and non-invasively assess patients’ liver health. The pair teamed up to launch the Multidisciplinary Nonalcoholic Fatty Liver Disease Clinic (NAFLD) in hopes of slowing an increasing epidemic.

Today, as an assistant professor on the University of Colorado Anschutz Medical Campus, Jensen’s memory fuels his outreach aimed at detecting what has become the most prevalent chronic liver disease in the United States. Rising in tandem with the obesity epidemic, Nonalcoholic Fatty Liver Disease (NAFLD) now strikes children as well as adults and is soon expected to become the top reason for liver transplants in this country.

“It was one of the toughest cases I saw in residency,” said Jensen, who joined the School of Medicine’s Division of Endocrinology, Metabolism and Diabetes in 2016. “He was intubated and on multiple medications and was very difficult to manage. I just remember thinking to myself: We need to have a better way of finding these people before it’s too late.”

Answering a call

Today, Jensen and Amanda Wieland, MD, of the Division of Gastroenterology and Hepatology, have launched the Multidisciplinary NAFLD Clinic, using a team approach that combines their expertise with that of top experts across the campus in decreasing the disease’s burden on patients and the health care system.

Red flags for NAFLD in patients

 

Obesity

Visceral fat (increased waist circumference)

Metabolic syndrome

Insulin resistance

Type 2 diabetes

High blood pressure

Sleep apnea

Some lipid disorders

High triglycerides

Some medications (e.g., some HIV drugs, Tamoxifen, Methotrexate, some steroids)

“Roughly 30 percent of the population has Fatty Liver Disease, doubling in incidence since the 1990s,” Jensen said. “We know that it’s not only preventable, but it also can be reversible largely through diet and exercise,” said Jensen, who hopes to extend the clinic hours with the addition of SOM’s Emily Schonfeld, MD, a gastroenterologist, to the staff this fall.

NAFLD – which results when fatty deposits (steatosis) collect in the liver because of something other than alcohol consumption – has strong links to obesity and heart and metabolic disease. While it strikes 8 percent of the lean population, NAFLD affects nearly 70 percent of diabetics and 80 percent of the morbidly obese.

If the cause goes unaddressed, liver inflammation, scarring and cell death (nonalcoholic steatohepatitis, or NASH) can result, ultimately leading to permanent tissue damage, or cirrhosis.

Missing a silent killer

With top-of-the-line screening equipment, the clinic’s team can identify cases and determine the severity, generally non-invasively, steering patients down the road to reversal. Jensen hopes more patients and primary care doctors, who often don’t have the knowledge, ability or time to effectively treat NAFLD patients, will seek expert care for themselves or their patients.

While primary care physicians routinely check liver function with blood tests, the Dallas Heart Study found the lab work was not a reliable marker, leaving patients undiagnosed, Jensen said. “On ultrasound, researchers found that up to 80 percent of those patients who did have fatty liver had normal-looking enzymes,” Jensen said.

Because doctors once thought simple steatosis would never progress to inflammation and scarring, non-specialists sometimes downplay early NAFLD, Jensen said. But studies now suggest within a six-year period, up to 40 percent of those patients do develop NASH.

“So, our sense is that it’s not only important to screen but to look at the risk factors that might suggest patients are susceptible and to monitor those patients.”

Life-changing diagnosis

Having lost his brother 10 years his junior last year to long-undiagnosed NAFLD, Aurora resident Dennis Ipsen considers himself lucky that his doctor sent him to Jensen and Wieland. The pair quickly detected the disease and began monitoring Ipsen.

“That’s what I liked the most,” Ipsen said of Jensen’s expertise and team approach. “He was Johnny-on-the-spot looking for this, and he knew what he was dealing with, and he brought in the other doctor very quickly,” said Ipsen, who has diabetes and heart disease. “The sooner it’s detected, the better off you are.”

Ipsen’s only new directive so far: maintain his chosen Weight Watchers diet plan. “I’m hoping that’s all I need,” he said.

“I just remember thinking to myself: We need to have a better way of finding these people before it’s too late.” – Thomas Jensen, MD

Rx: Weight loss

A healthy diet, exercise and weight loss is often the only prescription necessary with early diagnosis, Jensen said. “We know that with a 5 percent weight loss, you can reverse the level of fat in the liver,” he said. “And with a greater-than 10 percent weight loss, you can even start seeing reversal of fibrosis (early stages of scarring).”

At the NAFLD clinic, patients receive counseling on controlling related conditions and on ways of achieving weight loss, from fitness apps to bariatric surgery. “I had an obese patient with moderate steatosis,” Jensen said. She was a candidate for bariatric surgery and opted for that route. One month and 15 pounds later, a recheck found her fatty liver was completely resolved, Jensen said.

In addition to the Metabolic and Bariatric Program for severely overweight cases, the NAFLD clinic works closely with the CU Anschutz Health and Wellness Center in helping patients master lifestyle changes and achieve weight loss.

Keeping the faith

Valerie Frank family
Valerie Frank stands front and center of her family, which includes eight grandsons. Frank travels from her Sterling home to the CU Anschutz Medical Campus for specialist care for liver disease.

Although Valerie Frank’s disease had progressed to cirrhosis by the time she found the clinic, the Sterling resident dropped more than 40 pounds since diagnosis and holds out hope that Jensen’s and Wieland’s care can keep complications at bay.

“It’s still good to know,” said Frank, who has diabetes and spent more than a year seeing doctors and undergoing tests trying to find an answer for fatigue and abnormal blood work. She finally told her doctor she gave up. “And he said: Let’s try one last thing. Let’s have you see Dr. Jensen and Dr. Wieland at UCHealth.”

Three weeks later, after making the two-plus-hour trip from her Sterling home, Frank was diagnosed. Now, despite the drive and higher out-of-pocket costs, Frank said she will continue under the doctors’ care for as long as they can help her and would encourage other liver patients to do the same.

“Absolutely. From the minute I walked in, I felt a connection with them both,” said the mother of three and grandmother of eight grandsons. With cirrhosis, her prognosis is not certain, but she’s sure of one thing: The doctors are doing everything they can to give her the best outcome. “I’m feeling well. I’m doing well. You can’t give up on hope,” she said. “I have total faith in them.”

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trial commencing for Elipse Balloon

Enrollment for ENLIGHTEN, a United States clinical trial for the Elipse® Balloon – the world’s first and only procedureless™ gastric balloon for weight loss, has started at University of Colorado Hospital at the CU Anschutz Medical Campus.

The study is designed to evaluate the safety and efficacy of the Elipse Balloon in 400 individuals. It is administered by Allurion Technologies, a leader in the development of weight loss therapies. The study will be conducted at up to twelve sites in the United States. Dr. Shelby Sullivan, associate visiting professor of gastroenterology at the CU School of Medicine and a specialist in endoscopic bariatric weight-loss procedures is leading the trial in Colorado.

“We are excited to be the only center in Colorado enrolling patients in the ENLIGHTEN study, the first completely procedureless gastric balloon for weight loss,” Sullivan said. “A device like this which doesn’t require a procedure will lower the barriers for patients who need help with weight loss.”

The Elipse Balloon received its European Union CE mark in 2015 and is currently available in more than 40 weight loss centers in countries across Europe and the Middle East. Over 4,000 individuals have already been treated. Unlike other weight loss balloons, the Elipse Balloon is placed and removed without surgery, endoscopy, or anesthesia. It is swallowed in a capsule during a brief, outpatient office visit and remains in the stomach for approximately four months, after which it opens and passes naturally from the body.

“We are looking forward to adding to our global clinical trial experience with the Elipse Balloon,” said Ram Chuttani, M.D., Chief Medical Officer of Allurion. “Starting ENLIGHTEN is the first step toward bringing our flagship product to the United States where we can build upon the success we have had abroad.”

“The Elipse Balloon has the potential to revolutionize the way obesity is treated in the United States,” added Shantanu Gaur, M.D., Chief Executive Officer of Allurion. “Millions of Americans are struggling to lose weight, and they are calling for new options that are safe and effective. The ENLIGHTEN study is the next step in meeting this consumer need.”

The Elipse Balloon is made of a thin, flexible polymer film. The device is swallowed in a capsule and filled with liquid through a thin delivery catheter, which is then detached. The balloon remains in the stomach for approximately four months, after which it opens, allowing it to empty and pass naturally from the body without the need for a removal procedure.

A pilot clinical study and recent 135-patient clinical trial conducted outside the United States in overweight and obese individuals demonstrated an average weight loss of 29 to 33 pounds, approximately 15% of total body weight. Participants also saw improvements in their triglycerides, hemoglobin A1c (HbA1c) and quality of life.

Study visits will occur at the CU Anschutz Health and Wellness Center. Interested participants can learn more about the study, eligibility and how to register at http://balloontrial.com and http://clinicaltrials.gov/ct2/show/NCT03261453.

Image Source: Allurion Technologies

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Powerful food-derived antioxidant can halt, prevent fatty liver disease

As obesity continues to rise in the U.S., non-alcoholic fatty liver disease (NAFLD) has become a major public health issue, increasingly leading to cancer and liver transplants.

But new research from the University of Colorado Anschutz Medical Campus has discovered that a powerful antioxidant found in kiwi fruit, parsley, celery and papaya known as pyrroloquinoline quinone, or PQQ, can halt or prevent the progression of fatty liver disease in the offspring of mice fed a high-fat Western-style diet.

Dr. Karen Jonscher
Karen Jonscher, PhD, associate professor of anesthesiology and a physicist at CU Anschutz.

Growing evidence suggests that childhood obesity and fatty liver disease is influenced by maternal diet and the infant’s microbiome, the community of microorganisms inhabiting the body.

Jonscher and her colleagues found that mother mice fed a Western-style diet passed on the negative impacts of that diet to their offspring.

Jonscher’s earlier work on PQQ showed it helped turn back these detrimental effects in newborn mice in milder forms of liver disease. In this study, she demonstrated that it also works on the early offspring microbiome to prevent the development of fatty liver disease.

Over the past decade, it has become clear that the developing infant gut microbiome affects maturation of the immune system and gastrointestinal tract, metabolism, and brain development.

“Increasingly, evidence suggests that exposure to maternal obesity creates an inflammatory environment in utero. This leads to long-lasting postnatal disruptions of the offspring’s innate immune system and gut bacterial health, which may increase the risk for development of fatty liver disease,” Jonscher said.

Obesity, which often stems from a high-fat, high-cholesterol, sugary diet, is a major cause of NAFLD. According to the Journal of the American Medical Association, nearly 60 percent of American women of childbearing age are overweight or obese. Numerous studies suggest their children tend to have increased liver fat and a higher risk of becoming obese.

Kiwi fruit, among others, contains a powerful antioxidant shown to halt or prevent fatty liver disease in young mice.
Kiwi fruit, among others, contains a powerful antioxidant shown to halt or prevent fatty liver disease in young mice.

“Fatty liver disease is the number one liver disease in the world,” Jonscher said. “It is now the leading cause of liver transplants, eclipsing hepatitis in many areas of the U.S.”

The researchers found that they could halt and prevent liver disease from developing in young mice by feeding their mothers PQQ.

“Our results highlight the importance of the neonatal period as a critical developmental window to protect obese offspring from the harmful effects of diet-induced lipotoxicity and potentially halt the devastating trend of increasing pediatric NAFLD associated with childhood obesity,” the study said.

Jonscher noted that more work is required to determine if these studies might apply to humans.

“But there is a possibility that people with fatty liver disease could potentially benefit,” she said. “The supplement is available online and in grocery stores but individuals should consult their doctors first before using it.”

 

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CU Anschutz hosts student research forum

Why can a rhythmic tune halt the tremors and walking struggles in people with Parkinson’s disease, allowing them to dance with fluidity and box with precision? And why do some teenagers storm sobbing out of clinic doors when their providers broach the subject of weight control?

Those were two of 62 questions University of Colorado Anschutz Medical Campus students tackled as part of the 32nd Annual Student Research Forum. Posters stretched across the north and south towers of the Education 2 building, as the students presented their projects to about 400 of their instructors and peers.

“We’ve been told that the half-life of medical information is approximately seven years, so something that we are taught at the beginning of our first year of medical school may or may not be relevant at the end of our residency,” said David Nguyen, a third-year medical student, explaining the importance of the event. “Especially if we want to go into academic medicine, research is our bread and butter, and we need to stay informed.”

While learning research skills, students also benefit from networking, connecting with mentors, honing presentation skills, boosting resumes and delving into something new by taking part in research forums, said Will Dewispelaere, a second-year medical student. “We all have this inherent scientific desire to find out new things,” he said.

Will Dewispelaere
Will Dewispelaere, a volunteer presenter at the student research forum, studied the effect of rhythm on Parkinson’s patients’ brains.

Probing the Parkinson’s brain

Dewispelaere, whose undergraduate degree is in neuroscience, has had a long interest in disorders such as Parkinson’s disease (PD), a progressive neurodegenerative disease that leads to severe tremors, limb rigidity, slowness of movement and gait and balance problems.

“I’ve been involved with Parkinson’s research since my junior year in college,” he said. “For some time, we have known that if you ask some people with PD to walk, they’ll have trouble getting started. But if you ask them to snap their fingers or listen to music and then walk to the beat, they tend to have fewer problems.”

Research has linked the sound of rhythm to improvement of gait, velocity and postural stability, Dewispelaere said. “Preliminary findings showed music therapy could ease these common Parkinson’s symptoms, including depression and anxiety,” he said, noting the popularity of dancing and boxing classes for PD patients. “But no one really knew why.”

In his study, researchers compared the brains of 23 PD patients with 21 age-matched, healthy patients (HC), using a special imaging technique (magnetoencephalography). The participants tapped a button with their right fingers to rhythmic cues played in their left ears.

While both groups had similar activation in some areas of the brain, the PD group had increased activation in two right areas, one responsible for sound recognition and processing (superior temporal gyri), and the other important to the integration of sensory information, including hearing and self-motion (supramarginal).

“Our conclusion was that increased activity in these two regions of the brain allows for those with Parkinson’s disease to bypass some of their abnormal neural circuitry to generate regular movements,” Dewispelaere said.

Casillas and Vukovic
Paola Casillas and Nemanja Vukovic questioned the quality of weight-control communication between teens and health providers surrounding obesity for their project.

Closing a provider-teenager gap

Four-year medical student Paola Casillas and second-year medical student Nemanja Vukovic focused their project on improving provider and teenage patient communication regarding a top health issue of today: obesity.

“It started about six years ago with a medical student here who saw a lot of these conversations go downhill really quickly, with the teens leaving feeling very discouraged or crying or worse,” Vukovic said. “Feeling like these conversations were super counterproductive, she wanted to know what was turning these kids off,” he said.

With the help of a teenage advisory board, the students devised questions and formed focus groups, using 47 volunteers from Denver-area high schools. The most consistent finding revolved around providers’ use of the Body Mass Index (BMI) chart when initiating conversations about patients’ weight.

Most focus-group members said they disliked the tactic, Casillas said. “They said: ‘I’m not a dot on a screen. This isn’t getting to know me and finding out what I struggle with,” Casillas recounted.

Cultural and gender differences surrounding what family and peers considered appropriate weight also placed pressure on some teens. “The biggest thing we ultimately learned was that they really want the provider to get to know who they are, what their family is like, and their goals and motivations for wanting to lose weight,” Vukovic said.

The project also involved sending surveys to local providers who served teens. Nearly 70 percent of the providers reported almost always starting weight conversations with a BMI chart, with the majority also indicating that their weight-control counseling with teens was not very effective.

The good news: Both providers and teens want to see change. “I was surprised by how much they cared,” Casillas said of the high-school students. “They want to have these conversations with their providers, and they understand the importance of the issue.”

With most providers indicating interest in learning the results of the project and incorporating the findings into their practices, the student researchers aim to expand the study and develop a provider plan for tailoring weight conversations to individual patients, Vukovic said. “We found some areas of disconnect, and we are hoping to bridge those gaps.”

 

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Project takes AIM at rural students’ health and wellness

Elaine Belanksy of Rocky Mountain Prevention Research Center
Elaine Belansky, PhD, Rocky Mountain Prevention Research Center director, and co-principal investigator

After years of partnering with K-12 schools in the most impoverished area of the state, enhancing exercise and nutrition programs for healthier learning, a Colorado School of Public Health research team on the University of Colorado Anschutz Medical Campus has gained more than $3.5-million in funding to take its project to the next level.

Researchers with the Rocky Mountain Prevention Research Center were recently awarded two grants from The Colorado Health Foundation (TCHF) to continue their work in southeastern Colorado and San Luis Valley schools. The money allows for a significant expansion of the center’s strategic planning process, Assess, Identify, Make it Happen (AIM XL), through which district-level comprehensive health and wellness plans can be developed.

“What is most exciting to me is that this grant gives us a chance to continue our longstanding partnerships with these rural school districts and to expand our work to now support children’s emotional health in addition to physical activity and healthy eating,” said Elaine Belansky, PhD, RMPRC director and co-principal investigator of the Working to Improve School Health and the Healthy Eaters, Lifelong Movers (HELM) projects. “We’ve been focused on the obesity-prevention side of things, which is really important and a significant issue in rural Colorado, but so is emotional well-being.”

Longer reach, broader focus

Health project serves rural Colorado schools
The current RMPRC project encompasses 27 school districts in rural Colorado.

In HELM’s first three years alone, moderate to vigorous activity levels in elementary school PE classes increased by 66 percent, and nearly 100 evidence-based environment and policy changes to combat childhood obesity were implemented in the southern Colorado study area. The current project, which encompasses 27 school districts, now will align with the Whole School, Whole Community, Whole Child (WSCC) model.

WSCC’s holistic focus with attention to 10 components, ranging from physical education and physical activity to counseling and social services, could have a dramatic effect in the region, Belansky said.

“We’ve heard from so many principals and superintendents that their No. 1 concern about students is their mental health,” said Belansky, adding that the region’s high poverty levels bring stressors that can sabotage children’s learning. In the largely agricultural San Luis Valley, an area the size of New Jersey with a population so sparse it could not fill Mile High Stadium, health-care resources are also stretched thin.

Benjamin Ingman
Benjamin Ingman, PhD, principal investigator of AIM-XL.

“There is a lot of need there,” said Benjamin Ingman, PhD, principal investigator of AIM-XL. “Being able to bring this focus to the kids’ well-being is really important. Kids need to feel safe and be well-fed before they can start thinking about being successful and happy in school. I hope that this program will help these schools focus on some of these baseline concerns.”

Happy kids, better learners

During her years focused on southern Colorado’s rural areas, Belansky has heard many heart-wrenching stories related to hunger, parents in prison, family addictions and poor living conditions, all matters that make focusing on school difficult for students and place huge burdens on teachers and administrators.

The RMPRC, with the help of project manager Shannon Allen, PhD, and others, aims to ease those burdens by helping school districts bring all players  ̶  including community agencies, staff,

teachers, parents, administrators and students  ̶  to the table to build programs and partnerships that support students’ overall well-being. Ingman, who wrote the recent grant proposal, said he hopes lessons learned from the team’s work eventually will reach beyond rural boundaries and influence other schools to broaden their educational aims.

None of the work would be possible without Ingman’s dedication, TCHF’s funding, and the support of school districts in the San Luis Valley and southeastern Colorado, Belansky said. “I’m so proud that we have somebody who understands schools and how important it is to focus on the health and happiness of the child, not just academic achievement,” she said of Ingman. “And I’m really proud that all of these districts in rural Colorado value working on the WSCC model to make a child’s educational experience a richer one.”

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METHOD fitness app prescribes personalized exercise as medicine

The patient breathes harder as his workout intensifies. His metabolic fingerprint – heart rate, oxygen level and other data – streams onto a tablet in the form of a colorized digital bar that shows exactly what his muscles are doing and the fuels he’s burning.

Nicholas Edwards at CU Anschutz
Nicholas Edwards is the director of Exercise-Medicine Integration in the Department of Family Medicine at the CU School of Medicine.

“In the purple zone he’s stressing his anaerobic system, and in the red he’s going to burn muscle mass if he stays up there too long,” says Nicholas Edwards, director of Exercise-Medicine Integration in the Department of Family Medicine, CU School of Medicine. “The blue here represents his prime zone, where he performs best during exercise and creates the most energy, so he’s safely burning the most pound for pound right at this second.”

Edwards is also co-founder and chief scientific officer of METHOD, a CU spinoff company, that is proving to be a health game-changer by connecting exercise to medicine. The system gives thousands of pro athletes and patients access to individualized, real-time metabolic information that, when combined with a prescribed fitness regimen, builds strength and stamina, reduces injury, sheds weight and improves their response to treatment.

‘Medically based fitness plan’

METHOD app shows individualized biometric data
The METHOD app shows individualized, real-time metabolic information of athletes and patients.

These metabolic data points help tailor regimens to a specific physiology – whether the person be a pro athlete, weekend warrior or couch potato – to provide healthy outcomes across the continuum of care. “It’s literally like a medically based fitness plan,” says Edwards, who three years ago launched METHOD with an eye toward college and pro athletes. Among the first users were elite athletes who were patients in the Ascent Program at the Center for Dependency, Addiction, and Rehabilitation (CeDAR). The METHOD system has expanded to thousands of patients and athletes, including the NHL’s Colorado Avalanche, NFL teams as well as fitness facilities and centers for orthopedics and physical therapy from coast to coast.

Besides being a breakthrough approach –  making exercise a prescribed medicine – the METHOD app is a testament to the collaborative innovations regularly occurring on the CU Anschutz Medical Campus. Family Medicine owns a stake in the enterprise, which was assisted in its launch by CU Innovations. “We collaboratively worked on a system that covers the spectrum – orthopedics through physical therapy to human performance,” says Edwards, who has two business partners.

“Previously, there was nothing that quantified what a person in the gym, the rehab center or the weight room is doing metabolically in real-time,” he says. “Anaerobic exercise was a guess. Through METHOD, we’ve been able to identify somebody’s unique metabolic fingerprint to know what’s going on physiologically as they exercise.”

‘It’s been amazing’

Dan, a patient at UCHealth, went through the three stages of the METHOD system – evaluation, prescription for exercise, and monitoring – under Edwards’ supervision. Dan is a high-level crossfit competitor and works as a paramedic, so he understands the value of physiological data such as heart rate and energy thresholds. “Using the METHOD data, Nick built a training program specific to my capabilities that matched my heart rate and everything,” Dan says. “It’s been amazing. I’ve gotten stronger, faster and more physically fit in the last month and a half than I’ve done on my own, just kind of blind training, over the last year.”

‘This system really dials everything in.’– Nicholas Edwards, METHOD chief scientific officer

Meanwhile, people on the other end of the spectrum, the sedentary and obese, often tell Edwards they don’t know how to workout, feel pain when exercising or are simply intimidated. “The great thing about this system is we’re able to give them specific parameters to know exactly where they should exercise, the exact kind of exercise, and when to start and stop, so they change their body in a healthy and safe way,” he says. “This system really dials everything in.”

Because the app loads onto smartphones and synchs with heart rate monitors, it’s able to monitor whether a user is staying in a metabolic zone too long. “The phone will literally buzz and tell them to speed up or slow down their workout,” Edwards says. “The app has built-in coaching mechanisms across the board.”

‘Solidify best practices’

And the app acts as massive data repository that allows clinicians to view real-time data from users around the country. “I can monitor somebody on an exercise prescription in Maine or in Southern California and compare their outcomes to somebody here in Colorado,” says Edwards, who played college football at North Dakota State and is a former mixed martial professional. “Our goal is to solidify best practices over time.”

Colorado Avalanche and METHOD
The Colorado Avalanche use the METHOD system to monitor and analyze the metabolic fingerprint of each player in order to achieve optimum fitness.

Improved outcomes mean athletes get back on the ice or field faster, while patients, either those recovering from surgery or just going through physical therapy, return to their normal lives sooner, Edwards says. “The big payoff is that by optimizing patient outcomes we’re lowering the cost of care, because you’re eliminating guesswork and duplication of services.”

Ditching a worn-out formula

For example, METHOD renders obsolete the timeworn 220-minus-your-age formula for determining a person’s maximum heart rate. Edwards gives the example of a 55-year-old couch potato and a former pro hockey player of the same age. “If you do that old formula, they should exercise the exact same way, which is ludicrous,” he says. “We need to find something different that’s happening with that individual every single day, and that’s what we do with METHOD.”

When not directly coaching athletes and patients through exercise regimens, Edwards speaks about the benefits of METHOD and proper training across the U.S. at the NFL Combine, behavioral health and strength and conditioning conferences and other events. He notes that the system is “really starting to catch fire” as more people turn to individualized exercise regimens.

Edwards says METHOD will further elevate CU SOM’s stature as a global leader in innovation, wellness and health care outcomes. “We’re developing a lasting change – to make medicine and exercise collaborate long term.”

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Research investigates role of protein in obesity

Obesity in Latin America is increasingly concentrated among women of low socioeconomic status, but surprisingly little is known about what such women eat or how their diets compare to others.

protein sources

Yet in a study published recently in the American Journal of Human Biology, researchers at the CU Anschutz Medical Campus, in collaboration with colleagues at CU Boulder and the University of Costa Rica, tested an explanation for greater obesity among these women: limited access to dietary protein leads them to consume a lower proportion of protein in the diet, driving higher calorie intake and obesity.

The study, “Using the protein leverage hypothesis to understand socioeconomic variation in obesity,” examined elements of the protein leverage hypothesis in a sample of Costa Rican women.

“Studies conducted in a laboratory setting show that when people eat a diet with a lower proportion of protein, they tend to consume more calories,” said lead author Traci Bekelman, a post-doctoral fellow in pediatrics at the CU School of Medicine. “We tested out this relationship between protein and calories in a real world setting in order to provide insight into rising obesity among the poor in Latin America.”

According to the report, the majority of research on the dietary causes of obesity has focused on carbohydrates and fats. This study suggests that explanations for obesity, especially among populations with limited access to food, should not overlook the potential role of protein.

The protein leverage hypothesis predicts that protein intake is more tightly regulated by the body than intake of other macronutrients. If one does not eat enough protein, in grams, to achieve the body’s intake target, an appetite for protein drives individuals to keep eating and could result in excess calorie intake and obesity.

Consistent with expectations, researchers found that obesity was higher and the proportion of protein in the diet was lower among low socioeconomic status women compared to others. They also found an association between the proportion of protein in the diet and total calorie intake. As the proportion of protein in the diet increased, total calorie intake decreased.

Researchers also looked at the relationship between the proportion of protein in the diet and calorie intake within different socioeconomic groups. They expected that the relationship would be strongest for women of low socioeconomic status because the protein leverage hypothesis should be most relevant to populations on low protein diets, but they found this relationship to be strongest for women of middle- and high-socioeconomic status. They found no relationship among women of low socioeconomic status.

“One possible explanation for this unexpected finding is that women of low socioeconomic status cannot afford to continue eating until they reach the body’s protein intake target,” Bekelman said.

According to the report, researchers were surprised to find that over half the women in the full sample did not meet their protein requirements, revealing a potential public health issue, especially because the protein deficit is among women of childbearing age.

The cross-sectional study used a random sample of 135 women from San José whom researchers placed into one of three socioeconomic categories. Researchers interviewed the participants over a nine-month period to collect information on their body mass index and what they ate and drank.

The study should not be interpreted as a causal link between protein intake and obesity and had a number limitations related to study design. The report recommends that further research on the protein leverage hypothesis should include studies that measure energy balance by simultaneously collecting data on energy intake, energy expenditure and body weight.

At CU Anschutz, scientists engage in high-profile academic studies resulting in discoveries that contribute new information about the nature and treatment of disease to the rest of the world.

 

 

 

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Common antioxidant may guard against development of liver disease

A common antioxidant found in human breast milk and foods like kiwi fruit can protect against nonalcoholic fatty liver disease (NAFLD) in the offspring of obese mice, according to researchers at the  University of Colorado Anschutz Medical Campus.

“Pyrroloquinoline quinone, or PQQ, is a natural antioxidant found in soil and many foods and enriched in human breast milk,” said the study’s lead author Karen Jonscher, PhD, an associate professor of anesthesiology and a physicist at CU Anschutz. “When given to obese mouse mothers during pregnancy and lactation, we found it protected their offspring from developing symptoms of liver fat and damage that leads to NAFLD in early adulthood.”

Dr. Karen Jonscher
Karen Jonscher, PhD, associate professor of anesthesiology and a physicist at CU Anschutz.

The study, published online last week in the Journal of the Federation of American Societies for Experimental Biology, is the first to demonstrate that PQQ can protect offspring of obese mothers from acceleration of obesity-induced liver disease.

NAFLD is the most common liver disease in the world, affecting 20-30 percent of all adults in the U.S. and over 60 percent of those who are obese. It heightens the risk of cardiovascular disease, type 2 diabetes and liver cancer.

Scientists have found that mice fed a high fat, Western-style diet give birth to offspring with a higher chance of getting the disease.

“We know that infants born to mothers with obesity have a greater chance of developing NAFLD over their lifetime, and in fact one-third of obese children under 18 may have undiagnosed fatty liver disease that, when discovered, is more likely to be advanced at the time of diagnosis,” Jonscher said. “The goal of our study, which we carried out using a mouse model of obese pregnancy, was to determine whether a novel antioxidant given to mothers during pregnancy and breastfeeding could prevent the development of NAFLD in the offspring.”

Jonscher and her colleagues fed adult mice healthy diets or Western-style diets heavy on fat, sugar and cholesterol. They gave a subset of both groups PQQ in their drinking water.

Their offspring were kept on the diets for 20 weeks. Those fed a Western diet gained more weight than those on a healthy diet. PQQ did not change the weight gain but it did reduce the fat in the livers, even before the mice were born. The antioxidant also reduced inflammation in the livers of mice fed the Western diet. The researchers found that PQQ protected adult mice from fatty liver, even when it  was stopped after three weeks when the mice quit breastfeeding.

Jonscher believes the antioxidant may work by impacting pathways critical to the early onset of diseases associated with maternal obesity, high fat diets and inflammation.

PQQ is found in human breast milk, soy, parsley, celery, kiwi and papaya. It’s also found in soil and interstellar dust. Jonscher said it could possibly be used as a prenatal or lactation supplement to protect children of obese mothers from developing liver and cardiovascular disease in adulthood, but cautioned that pregnant women should always consult their doctor before taking any supplement.

“Perhaps supplementing the diet of obese pregnant mothers with PQQ, which has proven safe in several human studies, will be a therapeutic target worthy of more study in the battle to reduce the risk of NAFLD in babies,” Jonscher said.

 

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